The following assumptions were employed in determination of health care costs for hepatitis C:
- 75% of people who acquire HCV infection develop chronic hepatitis C.
- The health care costs of acute hepatitis C are small, due to the largely asymptomatic nature of newly acquired HCV infection, and therefore were not considered in the total costs.
- All people with chronic hepatitis C are at risk of progression to advanced liver disease complications.
- People can either remain in disease states or progress forward but not regress.
4.5.1 Treatment protocols and costs for HCV
Table 4.5.1 outlines treatment protocols for HCV and their cost estimates. Additional health care service items for stages 1-3, but for total period rather than per year are:- Liver ultrasound x 2
- Liver biopsy x 2
- Pathology services (HIV serology x 1, HBV serology x 1, Iron studies x 1, full blood count x 4, alpha-1-antytrypsin level x 1, caeruloplasmin level x 1, ANA/auto-antibodies x 1, HCV genotype x 1, HCV viral load x 1)
Hospitalisation is assumed to only be required for:
- Liver biopsy (day only stay)
- Liver failure (incorporated into total cost estimate)
- Hepatocellular carcinoma (incorporated into total cost estimate)
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Table 4.5.1 Treatment protocols and their costs for HCV disease
Table 4.5.1 is presented as a list in this HTML version for accessibility reasons. It is presented as a table in the PDF version.Disease stages and costs of health care services:
- Mild chronic hepatitis C1
- Doctor visits (specialist x 1, primary care x 2) - $164
- Pathology services (liver function tests x 2) - $39
- Moderate chronic hepatitis C1
- Doctor visits (specialist x 1, primary care x 2) - $164
- Pathology services (liver function tests x 2) - $39
- Compensated cirrhosis1
- Doctor visits (specialist x 2, primary care x 2) - $198
- Pathology services (liver function tests x 2, full blood count x 1, alpha-fetoprotein x 1, liver ultrasound x 1) - $182
- Liver failure2
- Without transplant (80% of patients), cost per patient - $164,340
- With transplant (20% of patients), cost of transplant - $75,000
- Expected cost per episode - $146,472
- Hepatocellular carcinoma2
- Without surgery (76% of patients), cost per patient - $117,895
- With surgery (33% of patients), cost per patient - $28,290
- Expected cost per episode - $88,325
1 Health care services are per year per case in disease stage, based on CMBS Schedule Fee (2000).
2 Cost estimates are previous Australian figures from Shiell et al (1994), without adjustment for inflation.